A Health Podyssey

While estimates vary, spending on prescription drugs in the United States exceeds $500 billion per year. This makes drug prices a perennial health policy topic.In this context, payers and manufacturers are in a constant battle. Manufacturers seek to expand their market while payers attempt to use their leverage to negotiate lower drug prices. Often, patients and clinicians are caught in the middle and left to navigate increasingly complex pharmaceutical insurance benefit design, tiered formularies, drug rebates, and drug coupon programs.On today's A Health Podyssey, Scott Howell, chief strategy officer of US pharmaceuticals at Novartis Pharmaceuticals, joins Health Affairs Editor-in-Chief Alan Weil to discuss how much the United States health system spends on drug utilization management.Howell and co-authors published a paper in the August 2021 issue of Health Affairs exploring the growing burden of drug utilization management and seeking to quantify its financial cost. They found combined costs shared among payers, manufacturers, physicians, and patients totaling almost a hundred billion dollars per year.Order the August 2021 issue.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

As part of Policy Spotlight, a new virtual event series from Health Affairs, Editor-in-Chief Alan Weil welcomed Chiquita Brooks-LaSure, the new Administrator of the Centers for Medicare and Medicaid Services (CMS) at the US Department of Health and Human Services for a one-on-one discussion about her priorities at CMS, where she oversees programs including Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and the HealthCare.gov health insurance marketplace.A former policy official who played a key role in guiding the Affordable Care Act (ACA) through passage and implementation, Brooks-LaSure has decades of experience in the federal government, Capitol Hill, and the private sector. In March 2020, Ms. Brooks-LaSure was the lead author on Building On The Gains Of The ACA: Federal Proposals To Improve Coverage And Affordability in Health Affairs' thematic issue on “The Affordable Care Act Turns 10.” The interview was conducted on August 12, 2021.The discussion covered a number of topics, including how the unfinished work of the Affordable Care Act (ACA) is an important effort to address health equity, access to coverage, person-centered care, maternal health, Section 1115 Medicaid waivers, the future of value-based payments, social determinants of health, behavioral health and telehealth.Brooks-LaSure co-authored and published a post, titled "Innovation At The Centers For Medicare And Medicaid Services: A Vision For The Next 10 Years," on the Health Affairs Blog on the same day as the event.Policy Spotlights feature conversations with influential health policy experts in Washington, DC, and beyond. Interested in attending future events? Sign up for Health Affairs Today or Health Affairs Sunday Update newsletters to be the first to hear about the upcoming events. Health Affairs is grateful to the Robert Wood Johnson Foundation and The Commonwealth Fund for their support of the “Affordable Care Act Turns 10” issue.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

In our multi-payer health care system, the pharmaceutical market involves the complex interplay of manufacturers, insurers, prescribers, and patients. Each seeks to protect its own interest, which can be counterproductive for overall system efficiency.The United States also has a high rate of generic drug use, which is considered a success story as the introduction of generics can rapidly and dramatically reduce drug prices. But we've had much less success with biosimilars, the generic equivalent of high-cost biologic drugs.James Robinson from the University of California, Berkeley School of Public Health joins A Health Podyssey to discuss pharmaceuticals, how they're priced, and how competition in the United States compares to other countries.Robinson is a contributing editor to Health Affairs and the co-author of two papers published in the August 2021 issue. In one, Robinson and coauthor Quentin Jarrion analyze prices for three drugs and 11 competing biosimilars in France's single payer health system. They find the launch of biosimilars in France is associated with price reductions for the originator drug and the similar drug. In the second paper, Robinson and coauthors investigated the economic burden of drug utilization management on payers, manufacturers, physicians, and patients. They report that all stakeholders would benefit from a de-escalation of utilization management, which could lower drug prices and increase patient access.Order the August 2021 issue.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Migrants on their way to another country and people seeking asylum are often overlooked in health policy. During the COVID-19 pandemic as immigration and asylum processes stalled, thousands of people were stranded at Mexico's northern border. With limited health care and sometimes crowded and unsanitary living conditions, COVID posed a significant risk.How Mexico's response to COVID-19 took into account the particular needs of in-transit migrants and asylum seekers is the topic of today's episode of A Health Podyssey. Ietza Bojorquez-Chapela from the College of the Northern Border and Cesar Infante from the National Institute of Public Health join Health Affairs Editor-in-Chief Alan Weil to discuss their research they and co-authors published in the July 2021 issue of Health Affairs, an issue dedicated to borders, immigrants, and health.In the issue, the authors examine COVID-19 health policy documents issued by Mexican federal, state, and municipal authorities. Exploring these documents — which were prepared between January and September of 2020 —they found that only seven out of 80 publicly available documents explicitly mentioned the health care needs of in-transit migrants and asylum seekers.Order your copy of the July 2021 issue of Health Affairs.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Children born in the United States are born US citizens. Some of these children are born to immigrant parents who returned to their country of origin, either voluntarily or because they were deported.In 2015, more than half a million US citizen children lived in Mexico having returned with their parents. These children may face language and school adjustments, stressful living arrangements and economic and heath challenges. Fewer than half of them report holding Mexican citizenship, complicating their access to health and social services.The well-being of US citizen children living in Mexico is the topic of today's A Health Podyssey. Sharon Borja, an assistant professor from the University of Houston, joins the program to discuss research she and colleagues published in the July 2021 issue of Health Affairs, an issue dedicated to borders, immigrants, and health.In the issue, Borja and colleagues investigated health insurance coverage among US citizen migrant children living in Mexico. They found that about half of US citizen migrant children living in Mexico had limited, inadequate health insurance, which is a barrier to receiving necessary health care services.Order your copy of the July 2021 issue of Health Affairs.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

BONUS EPISODEAs part of Policy Spotlight, a new virtual event series from Health Affairs, The Commonwealth Fund President David Blumenthal welcomed Micky Tripathi, the national coordinator for health information technology (IT), to an in-depth discussion of Biden administration's plans and priorities for health care data.The interview was conducted on July 1, 2021.At the Department of Health and Human Services, Micky Tripathi leads the formulation of the federal health IT strategy and coordinates federal health IT policies, standards, programs, and investments. Guest host David Blumenthal held the same post during the Obama administration from 2009 to 2011.The discussion covered a number of topics, including information blocking, interoperability, Biden's equity project, social determinants of health data, artificial intelligence, data privacy, and much more.Policy Spotlights feature conversations with influential health policy experts in Washington, DC, and beyond. Interested in attending future events? Sign up for Health Affairs Today or Health Affairs Sunday Update newsletters to be the first to hear about the upcoming events. Health Affairs is grateful to the Robert Wood Johnson Foundation and The Commonwealth Fund for their support of the “Affordable Care Act Turns 10” issue.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Sixty-eight percent of undocumented immigrants in the United States come from Mexico or Central America. As a result, deportation policies have a disproportionate effect on people of Hispanic origin.Immigration enforcement activity may influence behaviors like obtaining health care services; the effects of which can be felt throughout the community. On today's episode of A Health Podyssey, Abigail Friedman from the Yale School of Public Health joins the program to discuss the relationship between immigration enforcement and health care use. In the July issue of Health Affairs, which focuses exclusively on Borders, Immigration & Health, Dr. Friedman and coauthor Atheendar Venkataramani from the University of Pennsylvania analyzed the relationship between immigration enforcement activity and health care use. They focused on the comparison between adults of Hispanic origins and those not of Hispanic origin.The study ultimately found that aggressive deportation enforcement in the US may make undocumented immigrants and those close to them reluctant to seek medical care.Listen to Health Affairs Editor-in-Chief Alan Weil interview Abigail Friedman from the Yale School of Public Health on the chilling effects of US immigration enforcement, where undocumented immigrants and their families forgo necessary care for fear of attracting immigration authorities’ attention.Order your copy of the July 2021 issue of Health Affairs.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Roughly 45 million immigrants live in the United States today, a fourfold increase since the 1960s. Immigrants face unique challenges obtaining health care services. Some of the challenges are caused by explicit policies designed to limit or exclude immigrants from programs and benefits available to people born in the US. Other barriers relate to household income or the greater likelihood of having limited English proficiency.The health of immigrants in the United States is the topic of today's A Health Podyssey. Arturo Vargas Bustamante is a professor at the UCLA Fielding School of Public Health and faculty director of research at the UCLA Latino Policy and Politics Initiative. For the July issue of Health Affairs - focused exclusively on borders, immigrants and health - Bustamante and coauthors published a paper describing a range of health policy issues raised by the shifting demography of US immigrants. They explored health insurance, health status, and access to care over the past two decades across the immigration and citizenship continuum. They found that inequities between immigrants and US-born residents increased after The Great Recession and began to decline after the implementation of the Affordable Care Act.Listen to Health Affairs Editor-in-Chief Alan Weil interview UCLA's Arturo Vargas Bustamante about the health of immigrants in the US today and how the shifting demographics of the US are affecting health policies.Order your copy of the July 2021 issue of Health Affairs.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

With the US becoming more focused on addressing mental health, one important topic is how society responds to people experiencing mental health crises. A typical crisis response involves a 911 dispatcher sending a police officer to respond and provide support. However, the vast majority of police officers have little or no training for how to best respond to those in mental health crises. In addition, people with serious mental health disorders are at elevated risk of being harmed in confrontations with the police.About 30 years ago in Eugene, Oregon, a small group created an alternative program for people in crisis by sending trained mental health workers and EMTs to people experiencing mental health crises instead of the police. The program is called CAHOOTS (Crisis Assistance Helping Out On The Streets) and it's become a model for similar efforts around the country.The organization, run by White Bird Clinic, is the subject of a Leading To Health article in the June 2021 issue of Health Affairs. On today's A Health Podyssey, CAHOOTS co-founder David Zeiss joins Health Affairs Editor-in-Chief Alan Weil to discuss diverting people in a mental health crisis from a police response to a system designed around mental health needs. Order your copy of the July 2021 issue of Health Affairs.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts

Gun violence harms the health of victims and witnesses, but it also disrupts community social cohesion and behavioral norms. The people in communities that have experienced violence can suffer adverse health consequences, including post-traumatic stress disorder.Exposure to gun violence and the disproportionate burden of that violence in certain communities is the topic of today's A Health Podyssey. Sarah James, a postdoctoral fellow at Cornell University, joins Health Affairs Editor-in-Chief Alan Weil to discuss her research on adolescent exposure to deadly gun violence published in the June 2021 issue of Health Affairs. She and her coauthors analyzed data about adolescents living or attending school near a deadly gun violence incident in the past year. They found stark trends by race and ethnicity as well as income level.Listen to Health Affairs Editor-in-Chief Alan Weil interview Sarah James on the effects of adolescent exposure to deadly gun violence within 500 meters of home or school.This episode is sponsored by the Rural Health Research Gateway at the University of North Dakota.Order your copy of the July 2021 issue of Health Affairs.Subscribe: RSS | Apple Podcasts | Spotify | Stitcher | Google Podcasts